Taking Charge of Your Fertility

by Toni Weschler

  A man who helps with the daily minutia of life is undoubtedly more sexually attractive to his partner because she’ll be less likely to drop into bed, exhausted from having returned home from work, only to still have to cook, clean, and do laundry. Finally, she’ll be able to relax, knowing that there isn’t a lasagna-encrusted casserole dish in the sink and a pile of overflowing trash in the kitchen dating back to the Middle Ages.

  The bottom line is that nothing squelches a woman’s desire for sex quite like feeling like a perpetual nag. Or, worse yet, feeling like her partner’s nagging mom. So rather than thinking that foreplay starts in bed just minutes before intercourse, you should assume that choreplay is a sexy precursor to all that happens that night.

  Delayed gratification is so very underrated.

  While people find it fairly challenging to delay gratification in most situations, the one time where both men and women are amply rewarded is when a woman is sexually teased and then teased some more. In other words, it’s not just about technique. It’s about building up anticipation. So, rather than reaching for her clitoris the minute you get into bed, begin warming her up hours before with subtle signs of affection or sexy texts during the day. And once in bed, realize that for many women, it’s not just about intercourse—it’s about that journey during the day leading up to it.

  Don’t go anywhere south until she is completely warmed up.

  Nothing quite puts the brakes on a woman’s sexual arousal like her partner’s touching her clitoris before she is ready. For starters, inflicting pain should not be part of your lovemaking repertoire (well, save for the occasional S&M session, which we’ll leave for another book).

  In addition, remember that even if she starts to become lubricated, for most women, this is only an indication that she is starting to become aroused—not necessarily that she is ready to be touched on her clitoris. The best way to be sure that she is ready? As mentioned earlier: tease her by caressing her everywhere but her clitoris, until you have her begging to be touched there.

  Bring her to orgasm before you have one yourself.

  It tends to put a crimp on a woman’s ability to climax when her partner pulls out, rolls over, and starts snoring before she’s even warmed up. And let’s be honest, once a man has an orgasm, he’s less likely to be motivated to help his partner. On the other hand, you’ll appreciate the tradeoff when your partner is fully lubricated and ready to have intercourse after she’s had her own. Or, if it’s easier for her to bring herself to climax, make that part of your foreplay before you have intercourse.

  Use sexual positions that allow for more clitoral stimulation.

  Since her clitoris is outside her vagina, intercourse alone is simply not enough for most women. Of course, this is only an issue if your partner wants to orgasm during sex. Many women love having one before, since they find that it’s too hard, distracting, and time-consuming trying to climax during intercourse, when they would rather focus on the wonderful intimacy that sex provides.

  So there ya go. If you already do everything above, you must have one incredibly content and loving partner. But on the off chance that you might have learned a thing or two, you’ll much more likely become the type of lover that your partner has always fantasized about.

  CHAPTER 21

  Premenstrual Syndrome: You Mean It’s Not All in My Head?

  Ah, yes. Premenstrual syndrome: the common condition whose cause eludes researchers and doctors alike. At times, it seems as if there are as many theories about PMS as there are symptoms. “It’s a progesterone deficiency.” “No, it’s due to a vitamin deficiency.” “Actually, it’s related to prostaglandins.” “No, it’s obviously due to a neuroendocrine imbalance.”

  In fact, after finally winning the perennial argument that PMS is a real condition, women may be a bit chagrined to learn that yet again, the validity of their symptoms has come into question. In 2012, a widely publicized study found a woman’s premenstrual mood swings in particular may be just a reflection of the fact that they’re . . . um, moody. Well, as a practitioner who’s reviewed a chart or two, I’m going to write this brief overview, on the assumption that PMS is real and that it affects women in all kinds of physical and emotional ways.*

  So, with that in mind, what is PMS? Basically, it is a recurring condition that can cause a variety of unpleasant physical and emotional symptoms in the luteal (postovulatory) phase of the woman’s cycle. Although most women tend to experience it in the week or so leading up to menstruation, it can happen anytime from ovulation on. It primarily affects women over 25 and tends to worsen with age, especially for women who have given birth. The timing of the symptoms is often consistent within each woman, and thus charting may give you the opportunity to deal with it constructively.

  THOSE DELIGHTFUL SYMPTOMS

  It’s been estimated that as many as nine out of ten women experience at least some form of PMS during their reproductive years. Since it’s unclear what causes it, there are different theories as to how best to treat it. So if you are adversely affected by PMS, I would encourage you to explore your options, since there are practical ways in which you can alleviate many of your symptoms.

  Even the way symptoms are categorized varies among clinicians. Still, many classify them using some variation of what Dr. Elizabeth Vliet, in her book Screaming to Be Heard, refers to as “the seven PMS clusters.” They are shown in the box below.

  TYPES OF PMS SYMPTOMS*

  Affective Depression, irritability, anxiety, anger, tearfulness, panicky feelings

  Behavioral Impulsive actions, compulsions, agitation, lethargy, decreased motivation

  Autonomic Palpitations, nausea, constipation, dizziness, sweating, tremors, blurred vision, hot flashes

  Fluid/Electrolyte Bloating, water-weight gain, breast fullness, hand and foot swelling

  Dermatological Acne, oily hair, hives and rashes, herpes, and allergy outbreaks

  Cognitive (Brain) Decreased concentration, memory changes, word-retrieval problems, fuzzy thinking, foggy-brain feelings

  Pain Migraines, tension headaches, back pain, muscle and joint aches, breast pain, and neck stiffness

  PREMENSTRUAL DYSPHORIC DISORDER (PMDD)

  If what you experience in your luteal phase is so severe that it interferes with virtually all facets of your life, you probably have PMDD: Premenstrual Dysphoric Disorder, an intense form of PMS. It is similar to PMS, but if you have at least five of the symptoms in the list below (of which one is from the top four) you’re more likely to have PMDD:

  •feeling sad, hopeless, or self-deprecating

  •feeling tense, anxious, or “on edge”

  •marked mood changes interspersed with frequent tearfulness

  •persistent irritability, anger, and increased interpersonal conflicts

  •decreased interest in usual activities, which may be associated with withdrawal from social relationships

  •difficulty concentrating

  •feeling fatigued, lethargic, or lacking in energy

  •marked changes in appetite, which may be associated with binge eating or craving certain foods

  •hypersomnia or insomnia

  •a subjective feeling of being overwhelmed or out of control

  •other physical symptoms, such as breast tenderness or swelling, headaches, joint or muscle pain, a sensation of bloating, weight gain

  In order to be properly diagnosed, you must experience these symptoms during your luteal phase, and they will usually resolve within a few days of starting your period. However, if you experience them in your preovulatory phase as well, you most likely do not have PMS or PMDD, and will need to explore other possible conditions.

  DIAGNOSING AND CHARTING PMS

  The most important point in diagnosing Premenstrual Syndrome is that you determine whether the symptoms are cyclical in nature. Of course, its recurring nature is caused by the hormonal changes that occur in an ovulatory cycle. This means that, technically, women who don
’t ovulate shouldn’t experience classic PMS. That would include preadolescent girls as well as those who are pregnant or postmenopausal. One would also expect women on the pill to not experience PMS symptoms, since they don’t ovulate either, but for inexplicable reasons, they often have heightened symptoms.

  When trying to determine if you even have PMS, the first step is to chart your symptoms along with your fertility signs. By recording both, you can verify whether they’re cyclical and what factors may trigger them. Most women with PMS tend to notice the same symptoms from cycle to cycle. The best way to monitor the various symptoms is to write them to the left of the narrow columns at the bottom of your master chart, as in Daisy’s chart below.

  Many women find that color coding is an excellent way to immediately visualize when they occur in the cycle. Use colors that you associate with various conditions. For example, if you feel irritable, use an annoying color such as fluorescent green. Or:

  Depressed Blue

  Headache Red

  Breast tenderness Pink

  Chocolate cravings Brown

  Hannah’s chart. Charting PMS signs. Hannah records various PMS signs using different colors near the bottom of the chart. This allows her to quickly determine whether her symptoms are cyclical or indicative of a problem requiring medical attention.

  TREATING PMS

  Once you have determined the cyclical nature of your PMS symptoms, you can decide on the appropriate steps to take. Many women find that just being able to anticipate when they will occur can help deal with them. When you realize that your depression, irritability, or headache is only a sign that your period is a few days away, you should have less cause for concern. Often the symptoms themselves create needless anxiety as women wonder if they are “going crazy” or suffering from a serious illness. The knowledge and control that come with charting can be the first step in managing PMS.

  There are many self-help therapies that seem to work well for women, but if you suffer severe symptoms, I would encourage you to get medically evaluated before attempting to treat yourself through change in diet, vitamins, or minerals. Severe PMS (such as debilitating depression or panic attacks) can be an indication that you have underlying problems that may require hormone therapy.

  Treatments range from alternative health care to traditional medical therapy, with self-help approaches somewhere in the middle. Your goal should be to discover the best solution for your particular situation. I have listed self-help treatments first, since they tend to be the easiest and most accessible for most women.

  Self-Help Approaches

  Self-help therapy is geared toward preventing PMS altogether, rather than just treating the symptoms. Of course, you may not always be able to do so, in which case you may want to take one of the over-the-counter drugs discussed here. If you are charting your cycle, be on the lookout for when you have your thermal shift, so that you can be especially attentive to the following suggestions.

  Dietary Considerations

  There is probably no better way to control PMS symptoms than proper diet. The nutritional guidelines recommended by almost all experts emphasize a well-balanced diet of whole grains, fruits, and vegetables, including legumes. And, as expected, PMS symptoms can be greatly alleviated by dramatically cutting back on everything that you no doubt love, including most foods that are high in sugar, salt, and fat. Substances such as alcohol, nicotine, and caffeine—and, yes, even chocolate—should be avoided. Of course, the cure may be worse than the condition. Believe me, I hear ya. But regardless, you may want to increase your intake of complex carbohydrates while decreasing that of protein, as well as eat more frequent, smaller-portioned meals.

  You should know that many nutritionists believe that a variety of vitamins, minerals, and herbs may go a long way in alleviating various PMS symptoms, such as vitamin B6, vitamin E, calcium, magnesium, and evening primrose oil. Finally, many women appear to get excellent results from using the supplement Optivite P.M.T., as well as others with similar ingredients.

  Exercise and Yoga

  You just can’t seem to get away from advice to exercise, can you? Whether your concern is weight loss, lowering cholesterol levels, maintaining cardiovascular fitness, or PMS, the bottom line is that exercise is an excellent therapy for numerous ailments. One reason is that it activates the production of endorphins, a naturally occurring stimulant in your body. This explains why people usually feel so good after exercising. The trick to using exercise to benefit you the most is to maintain a regular exercise program of at least three to five times a week, about 30 minutes each session.

  In addition to vigorous exercise, yoga is an excellent source of relief for many PMS sufferers. Traditionally, the goal of yoga has been to promote balance and harmony. Adherents of yoga will tell you there’s nothing better for promoting health on all levels—physical, mental, emotional, and spiritual.

  Rest

  Of course, once you’ve exercised, you have to rest sufficiently to maintain optimal health. The common wisdom is that people should get at least 7 to 8 hours of sleep per night. Some need more. Ultimately, your body will tell you what feels best. Some women find that something as simple as going to bed earlier helps lessen PMS symptoms.

  Stress Reduction

  Who today doesn’t experience stress at least occasionally? Of course, some stress is inevitable. Still, do whatever you can to eliminate at least some of it from your life, whether it be through massage, yoga, meditation, dancing, or going to a movie. Whatever you do, at least be aware that stress in the postovulatory phase is going to exacerbate your PMS symptoms.

  Coping with Emotions

  For many women, one of the most distressing aspects of PMS is feeling out of control every cycle. It’s as if their emotions are exaggerated tenfold. It can be especially distressing to women who are used to thinking of themselves as caring and warm people. They often feel as if their anger, anxiety, or depression are out of character for them. But remember, women in our society are socialized to always be nice, always be the caretaker, always be giving, and never show dissatisfaction. Perhaps a better way to perceive your premenstrual emotions is to recognize that it is a time when you finally allow yourself to express the frustrations society expects you to suppress.

  Of course, if you feel that the intensity of your emotions during this time is incapacitating or harmful to your relationships, you may benefit from the help of a therapist in addition to consulting a clinician. Because therapists are more objective, they can often help clarify if the problem is hormonally based. Remember, PMS doesn’t cause emotions, but it will exaggerate what is already there.

  Nonprescription Drugs

  There are currently a variety of over-the-counter drugs designed to deal with specific PMS symptoms. These drugs, which include various analgesics, antihistamines, and diuretics, have proven effective against such symptoms as uterine cramps, headaches, and breast tenderness. Again, I suggest that you read the relevant sections of a more comprehensive PMS book or, at a minimum, talk to an informed pharmacist. Finally, it should be clear that while drugs such as Tylenol and Advil will certainly relieve many discomforts, a concerted regimen of healthy diet and vigorous exercise would do more by minimizing such symptoms in the first place.

  Complementary Health Care

  As mentioned in Chapter 9 on natural ways to balance your hormones, traditional Chinese medicine as well as naturopathic treatments may be helpful for some women, but you need to consult a qualified practitioner who is trained to diagnose you as a whole person, and not just examine your symptoms. Some successfully use either acupuncture or acupressure, both of which perceive PMS as the result of imbalance or blockage of vital energy, or qi (pronounced “chee”). Osteopathy, reflexology, and aromatherapy may be helpful as well. Of course, in all these cases, you need to consult a professional to determine if these might work for you. Many of the more specialized PMS books discuss the theory and practice of complementary treatments in more detail.


  Using Drugs and Alternative Therapies Together

  You may prefer to try to eliminate PMS through the natural alternatives just discussed. However, your symptoms may be so severe that you might want the quick relief drugs can provide. The good news is that natural and medical therapies aren’t mutually exclusive. You can use medication for severe symptoms while simultaneously changing your lifestyle to try to prevent PMS symptoms in the future. Eventually, then, you could go off drugs altogether and rely strictly on natural means to control your symptoms.

  Traditional Medical Treatments

  There are a number of standard medical therapies that you may want to try. But before consulting with your physician, it will help to have charted your symptoms for several cycles so that he or she can efficiently arrive at the most accurate diagnosis.

  Diuretics

  Many doctors prescribe diuretics for women whose PMS causes weight gain, bloating, and breast tenderness due to fluid retention. However, some clinicians believe that the first treatment should be to balance hormones and improve diet, allowing the symptoms to diminish on their own.

  Hormone Therapy

  Unfortunately, because there are conflicting theories regarding the primary cause of PMS, the proposed hormonal treatments also vary. Those who think that it’s due to low estrogen levels in the luteal phase believe that an oral contraceptive with the least amount of progestins may provide substantial relief for those with severe PMS, but you probably know by now that you would likely be better off avoiding the pill. Those who think it’s due to a progesterone deficiency believe that natural progesterone creams rather than artificial progestins utilized during the latter 2 weeks of the cycle can be effective in diminishing symptoms.

  If you prefer to use the more natural approach, you should try to consult with a doctor who is familiar with the use of the newest progesterone creams. Although there may be some risk to certain women, they are generally easy to use and have few side effects. Progesterone therapy has now gained wide acceptance as a treatment with potentially great benefits for many women.